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目的：提出一种治疗创伤性寰枢椎不稳的新手术方法——前路经寰枢关节螺钉内固定术，并通过建立模拟手术模型和评价安全性，验证其临床应用的可行性。方法：在１７具人体标本的术前颈椎Ｘ线片上作５条辅助线，取右侧颌下切口，根据术前计划，经枢椎椎体－寰枢关节－寰椎侧块方向置入螺钉。在术后Ｘ线片上测量螺钉轨道参数，与术前计划参数作ｔ检验。在经寰椎横突上、下缘及枢椎上关节面下缘三个横断面上测量螺钉与椎动脉的距离。统计椎动脉、脊髓及枕颈关节损伤的例数。结果：①术前计划参数：内界角１８°±１．４°，外界角３３°±３．７°，标准外偏角２６°±２．９°，后界角３９°±４．１°，标准后倾角２４°±２．０°。②螺钉轨道实际外偏角２４°±３．５°，实际后倾角２７°±４．０°，与术前参数比较无显著性差异（Ｐ＞０．０５）。③在经枢椎上关节面下缘的横断面上螺钉与椎动脉距离最短，平均值６ｍｍ，最小值３．５ｍｍ，无椎动脉及脊髓损伤，２例枕颈关节损伤。结论：前路经寰枢关节螺钉内固定术与后路内固定术互为补充。经应用解剖研究证明其具有较高的安全性和较大的临床实用性。
OBJECTIVE: To propose a new surgical method for the treatment of traumatic atlantoaxial instability, anterior atlantoaxial arthrodesis, and to verify the feasibility of its clinical application by establishing a simulated surgical model and evaluating its safety. Methods: Five auxiliary lines were made on preoperative cervical X-ray of 17 human specimens. The right submandibular incision was made. According to the preoperative planning, the screw was inserted through the lateral vertebral body-atlantoaxial joint . The screw orbital parameters were measured on postoperative X-ray and t-test was performed with preoperative planning parameters. The distance between the screw and the vertebral artery was measured on three transverse sections of the transverse process of the atlas, the inferior margin and the lower edge of the superior articular surface. Statistics vertebral artery, spinal cord and occipital neck joint injury cases. Results: ① Preoperative planning parameters: internal angle 18 ° ± 1.4 °, external angle 33 ° ± 3.7 °, standard external angle 26 ° ± 2.9 ° and back angle 39 ° ± 4.1 °, the standard back angle of 24 ° ± 2.0 °. (2) The actual deviation angle of screw track was 24 ° ± 3.5 ° and the actual incline angle was 27 ° ± 4.0 °, which showed no significant difference compared with preoperative parameters (P> 0.05). ③ In the cross-section of the lower edge of the superior articular surface, the distance between the screw and the vertebral artery was the shortest, with an average of 6 mm and a minimum of 3.5 mm. There was no vertebral artery and spinal cord injury, and 2 cases of occipital and cervical joint injury. CONCLUSION: Anterior approaches are complemented by atlantoaxial arthrodesis and posterior fixation. The application of anatomical studies have shown that it has high safety and greater clinical utility.